2. • Objectives
• Introduction of emergency contraceptives
• Types of emergency contraceptives
• When to prescribe emergency contraceptives
• Side effects of emergency contraceptive pills (ECPs) and management
• Effectiveness of ECPs
• Discussion of future contraception options
• Summary of the presentation
Outline
3. 1. Define emergency contraceptive
2. List types of emergency contraceptives
3. Identify candidates for emergency contraceptives
4. Discuss mechanisms of action
5. Explain common side effects of emergency contraceptive
pills
Objectives
4. • Use of drugs or a device as an emergency measure to prevent
pregnancy
• ECPs are also called: “Morning After Pill” or post-coital
contraceptives
Definition
5. • Special ECPs with
• the progestin (levonorgestrel)
• estrogen and levonorgestrel
• Progestin-only pills with levonorgestrel or norgestrel
• Combined oral contraceptives with an estrogen and a progestin
• levonorgestrel
• norgestrel or norethindrone
• Intrauterine contraceptive device (IUCD)
Pills or Devices for Emergency Contraceptive
6. When to take Emergency contraceptives?
As soon as possible after unprotected sex
Any time up to 5 days after unprotected sex
7. • Who is a candidate for ECPs?
• All women can use ECPs safely and effectively
• Unprotected sex
• Condom rupture, slippage
• Missed pills, 3 or more doses
• Sexual assault
No known medical conditions make ECPs unsafe for any woman
Emergency Contraceptive Pills
8. • Progesterone only dedicated product(post pill)
• 1.5 mg of levonorgestrel in a single dose or
• 0.75 mg levonorgestrel (follow with same dose 12 hours
later)
• Most recommended ECPs
Dose(s) of Emergency Contraceptive Pills
9. • Estrogen progestin dedicated product
• 0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel (follow
with same dose 12 hours later)
• Progestin-only pills with levonorgestrel or norgestrel
• Levonorgestrel pills 1.5 mg in a single dose
• Norgestrel pills 3 mg in a single dose
Dose(s) of Emergency Contraceptive Pills (cont’d)
10. • Combined oral contraceptives
• 0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel (follow with
same dose 12 hours later)
• 0.1 mg ethinyl estradiol + 1 mg norgestrel (follow with same
dose 12 hours later)
• 0.1 mg ethinyl estradiol + 2 mg norethindrone (follow with
same dose 12 hours later)
Dose(s) of Emergency Contraceptive Pills (cont’d)
13. • Emergency contraceptive pills:
• Do not cause abortion
• Do not cause birth defects if pregnancy occurs
• Are not dangerous to a woman’s health
• Do not promote risky sexual behavior
• Do not make women infertile
Facts About ECPs
14. • Changes in bleeding patterns may include:
• Slight irregular bleeding for 1–2 days after taking ECPs
• Monthly bleeding that starts earlier or later than expected
• Nausea
• Routine use of anti-nausea medications not recommended
• Give anti-nausea medication for clients with
• previous ECPs use
• first dose of a 2-dose regimen
• Vomiting: If within 2 hours after taking ECPs give another dose
Side Effects of ECPs and Management
15. • No routine return visit is required
• However, a woman should seek follow-up care if:
• She thinks she might be pregnant
• She has no monthly bleeding
• Or her next menses is delayed by more than one week
Side Effects of ECPs and Management (cont’d)
16. • ECPs does not protect from pregnancy
• If she does not want to start a contraceptive method now
• give condoms
• oral contraceptives
• Invite her to come back anytime
• If possible, give her more ECPs (for future use)
Planning Future Contraception
17. Should women use ECPs as a regular method of contraception?
No
Planning Future Contraception (cont’d)
Nearly all other contraceptive methods are more effective in preventing
pregnancy
Women who use ECPs regularly are at high risk to have unintended
pregnancy
18. • Should be inserted within 120 hours
• Highly effective
• Can remain in place for up to 10 years
• Good option for long-term contraception
IUCD (Copper IUCD)
19. • Uterine abnormalities/anomalies
• Acute pelvic inflammatory disease or in the past 3 months
• Pelvic malignancies: Cervical cancer and endometrial cancer
• Undiagnosed abnormal vaginal bleeding
• Allergies to copper
Some Contraindications for IUCD
20. • Ulipristal acetate
• Highly effective and well-tolerated
• Can be taken up to 5 days after unprotected sex
• Believed to be more effective than levonorgestrel ECPs
• Mifepristone
• Highly effective, with few side-effects
•Both are not included in our guideline
Other Types of Emergency Contraceptive
21. • 20 year old female college student
• Unprotected sex 12 hours back
• Last normal menses was 2 weeks back
• Unmarried, with no immediate plan for children
• On antibiotics for pelvic inflammatory disease
Which of the emergency contraceptive do you recommend
based on Ethiopian Ministry of Health family planning guideline?
Case Study
23. • Levonorgestrel-only dedicated is the most recommended type of
ECPs
• Emergency contraceptives prevent pregnancy when taken up to
5 days after unprotected sex
• Emergency contraceptives do not disrupt an existing pregnancy
• ECPs are safe for all women
• ECPs are not recommended as regular contraceptive methods
Summary
Editor's Notes
The sooner emergency contraceptive are taken after unprotected sex, the better they prevent pregnancy.
Remember that many pills may be taken if progesterone only or combined oral contraceptive are used as ECPs
Ulipristal acetate available United States (sold as ella) and Europe (sold as ellaOne)
This type of emergency contraceptive pill is currently available only in China, Vietnam, Armenia and Russia.
